Peterson, Douglas E

Peterson, Douglas E is an individual health care provider with primary practice located at 263 Farmington Ave , Farmington CT 06030-0001. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Peterson, Douglas E can be contacted via phone (860) 679-2952.

Contact Information

Primary practice address
263 Farmington Ave Farmington CT 06030-0001
Phone: (860) 679-2952
Fax: (860) 679-4760
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 007480 Connecticut
Dental Providers / Dentist 122300000X 007480 Connecticut

Profile Details

NPI number 1003813445
LBN Legal business name Peterson, Douglas E
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2005
Last updated May 12th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003813445 NPPES
Connecticut MEDICAID 1003813445

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